TRADE JAN -07-2011 02:40 PM BEASLEY•S*HEATING &AIR 919 894 8420 P.02
_ Application # 1'ff)c)1:1r4) i,.3 - 1 1
Mail In annllcation
Please note if this application Harnett County Central Permitting
is pan of a job in pmlpess PO Box 65 LIIlington, NC 27546
with open permits. 910 -893 -7525 Fax 910-893-2793
_.._ yes --_.._ no
www. h amett.org /permits
Certification of Work Performed by Owner/Contratxor
(Individual Trade Application)
Contractor Information
d j1 will complete the i��i(t jfjl: iek(4, ti t /iC. work on the project or
(Name) WO (Tra e)
structure herein described, My state license number is ( 'j : All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: 1 : 1 �Oa ".�e. � :.� j kel.7 I�j Y'1 ci 1 \1v I ✓`1l ._._.
Malting Address: ‘ LJC 12'xx7k 5* - C cs n.-.
Stmet Address: Cr f :�... ' k( :21 4-1 _
Business Phone: 1' i C 1 u ` L i c) `S Email Address: r4,6)bIL 4
'Company name, address, i phone must match Inrormadon an ncsnse.
Job Information
Land Owner's Name: tAY Y C4.' ( t,t.•V Y \ Y'\ Phone: �''r�11 -�� 25 ,1?
Tenant/Building Owner (if different): Phone:
Construction or Site Address: ( 7 1 0 9 .S ('h 1) o ) Si (\:(1).2 /UP_
PIN or Parcel # from GIS: _
Soeafplroctions to Job from Lillinoton:
Description of work to be done: C . `la I IC C t c £ 1 i7 Job Cost: Lt) C-
Mechanical: New Unit With Ductwork __ - New Unit without Ductwork i‘ Gas Piping _—
Electrical: 200 Amp _ <200 Amp Service Change _ Service Reconnect Other _
Plumbing: Water /Sewer Tap _- Number of Baths Water Heater
Permit Cost
r '
Pemdt Fee: $ rC ) - (calculated from fee schedule)
Mail In Processing Fee: $3.90 ner lob For Electrical Permits with Progress Energy we
creed the premise number provided.
r
Total Enclosed: $ � )
Make check payable & Ma completed application form to: Hamett County Central Permitting (HCCP)
PO Box 85
/ Lillington, NC 27546
•
Contractors Signature: �t e c �, C. Y) Date: .
"'DO NOT SEND CASH. INCOMPLETE APPLICATIONS MU. NOT BE PROCESSED'"`